| Certificate Number | 550 | | Date Issued |
| Child Given Name | Martin |
Ferguson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Dec 1882 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Abraham |
Ferguson | Father's Surname |
| Father's Occupation | Laborer | Norwegian | Father's Nationality |
| Father's Birth Place | Norway | 29 | Father's Age |
| Mother's Given Name | Mary Serene | | Mother's Maiden Name |
| Mother's Surname | Ferguson | | Mother's Residence |
| Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
| Mother's Age | 24 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Martha E. Ferguson | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | Martha E. Ferguson | Cambridge IA | Certificate Signer's Address |
| Returned by Name | Martha E. Ferguson | | |